Coding, Classification & Reimbursement

O34.219 vs Z98.891

  • 1.  O34.219 vs Z98.891

    Posted 15 days ago
    Hi

    Im struggling with which to use when a Mother is pregnant and has a history of c-section. Also, if they have a regular(not pregnant) ob/gyn visit. I have an article written by AAPC September 25, 2017 stating O34.211 is for postpartum after delivery of c-section and Z98.891 used when a previous or current c-section scar. Can someone tell when to use these codes because  I have coders using O34.211 with just a regular office visit with a history of c-section and inpatient with vaginal delivery after previous c-section

    ------------------------------
    Kathleen Cariello

    ------------------------------


  • 2.  RE: O34.219 vs Z98.891

    Posted 15 days ago
    This should answer your question.
    Basically, if pregnant again and the scar is not causing problems, use the Z code, and if it is problematic requiring attention, use O34.21-.

    ------------------------------
    Blake Guillot, RHIT
    Medical Scribe
    ------------------------------



  • 3.  RE: O34.219 vs Z98.891

    Posted 15 days ago
    Hi

    Ok, I have a case where the patient came in for a repeat c-section(inpatient chart), the coder coded: O34.219 Maternal care for unspecified type scar from previous cesarean delivery. I have always coded this as Z98.891 History of uterine scar from previous surgery. I have never been told nor has any Auditor or CDI have told me different. The OP report does not state if they used previous scar. Which would you code? Maternal care or history.

    ------------------------------
    Kathleen Cariello

    ------------------------------



  • 4.  RE: O34.219 vs Z98.891

    Posted 15 days ago
    Hi.

    Please refer to Coding Clinic, 2016 Q4, pp. 76-79 which states, "For a patient who is currently pregnant, a code from subcategory O34.2 should be used instead of Z98.891."

    ------------------------------
    Cheryl Anderson, CCS, CCS-P
    Coding Auditor
    ------------------------------



  • 5.  RE: O34.219 vs Z98.891

    Posted 14 days ago
    ​Hello!

    Please see Official Guideline I.C.15.a.1, " Should the provider document that the pregnancy is incidental to the encounter, then code Z33.1, Pregnant state, incidental, should be used in place of any chapter 15 codes.  It is the provider's responsibility to state that the condition being treated is not affecting the pregnancy."

    In your case, the pregnancy is not incidental; it is the reason for admission.  Furthermore, based on the provided scenario, the prior C-section is the reason for the repeat C-section.  Even in cases of VBAC, the O34 code should be assigned in cases where the patient is pregnant unless the provider states the prior C-section is not affecting the pregnancy.  This would be very rare.

    ------------------------------
    Lawrence Barr
    President
    ------------------------------